| NPI | 1740559871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY BASTOW Presiden 269-637-1388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MI 5101008849) |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2012-06-08 |